According to best practice guidelines, what should skilled nursing facility compliance officers do if an audit reveals claims did not meet medical necessity?

Reporting to CMS within 60 days is essential when an audit reveals claims did not meet medical necessity because it aligns with federal compliance regulations. Skilled nursing facilities must adhere to these guidelines to ensure transparency and accountability in billing practices. Failing to report could result in significant penalties or sanctions against the facility, as it reflects a lack of adherence to established laws designed to protect the integrity of the Medicare and Medicaid programs.

Timely reporting is also crucial for corrective actions and maintaining a compliant environment. This process helps to mitigate potential fraud and abuse by addressing issues proactively. Moreover, it demonstrates the facility's commitment to ethical practices and its responsibility in ensuring that only necessary services are billed.

In contrast, while reporting to facility management and revising internal policies are important components of a comprehensive compliance strategy, they do not fulfill the immediate legal obligation stemming from the audit findings. Ignoring the findings is unequivocally detrimental to compliance and can lead to greater issues down the line.